Neonatal Umbilical Inflammation

　　Most often caused by improper handling during or after the umbilical cord cutting. Inadequate disinfection and poor care can easily cause bacterial contamination and lead to umbilical cord inflammation. Common pathogens: Staphylococcus aureus, Escherichia coli, followed by hemolytic streptococcus, or mixed bacterial infection, etc., as well as the impact of foreign body stimulation, which can lead to the possibility of umbilical inflammation.

　　Mild cases may have slight redness and swelling around the umbilical cord and the surrounding skin, accompanied by a small amount of serous purulent secretion. Severe cases may have obvious redness, swelling, and hardness around the umbilical cord and the surrounding skin, with purulent secretion and a large amount, often with an unpleasant smell. It can spread to the surrounding skin or tissue, causing cellulitis of the abdominal wall, subcutaneous gangrene, peritonitis, sepsis, portal vein inflammation, and later may develop into portal hypertension, liver cirrhosis.

　　The earliest sign of umbilical cord inflammation is redness at the base of the umbilical cord, or the wound does not heal after falling off, the umbilical sinus is moist and has discharge. Later, the skin around the umbilical cord becomes red and swollen, there is serous purulent secretion in the umbilical sinus, with an unpleasant smell, the skin around the umbilical cord becomes more red and swollen, or local abscesses may form, sepsis, severe illness may cause peritonitis, and systemic toxic symptoms. Fever, refusal to breastfeed, poor spirits, irritability, etc. Chronic umbilical inflammation may form granulomas locally, which are small cherry-red swellings that protrude and often discharge sticky secretions, and are difficult to heal for a long time.

　　The key to prevention lies in strict aseptic operation when cutting the umbilical cord, and the utensils used for cutting the umbilical cord and the suture thread for tying the umbilical cord must be strictly disinfected. In case of emergencies, if the disinfection is not strict during delivery, the umbilical cord should be cut again and disinfected strictly within a few hours.

　　Before and after the umbilical cord stump falls off, change the diapers frequently to keep the umbilical cord clean and dry. It can be wiped with 75% medical alcohol around the umbilical cord stump and the surrounding area 2-3 times a day. If scabs form, lift the scabs while wiping the alcohol from the inside out to truly achieve the effect of disinfection.

　　Attention should also be paid not to use drugs with color, such as gentian violet and mercuric red, because the color of the drug can affect the observation of the umbilical cord; also do not use powdery drugs such as cornstarch and body powder, because the stimulation of foreign bodies can cause chronic inflammation of the umbilical cord and form granulomas, which are difficult to heal.

　　If redness or purulent secretion at the umbilical cord is found, or other signs of umbilical inflammation, it is necessary to go to the hospital for medical consultation in a timely manner.

　　1. The clinical manifestations include redness at the base of the umbilical cord, or the wound does not heal after falling off, the umbilical sinus is moist and has discharge, which is the earliest sign of umbilical cord inflammation. Later, the skin around the umbilical cord becomes red and swollen, there is serous purulent secretion in the umbilical sinus, with an unpleasant smell, the skin around the umbilical cord becomes more red and swollen, or local abscesses may form.

　　2. Routine blood tests and other examinations.

　　1. Clean and dry the umbilical cord stump. If there are redness and increased secretion in the umbilical sinus, use a disinfected cotton swab dipped in 75% alcohol to remove the secretion, then apply 1% iodophor solution and pay attention to the gauze bandage wrapped around the umbilical cord, which should not be loose or displaced. If it is contaminated by urine or feces, it should be changed in a timely manner.

　　2. If there is white purulent secretion with an odor at the root of the umbilical cord, umbilical inflammation may occur, and immediate hospital treatment should be sought.

　　3. Breastfeeding

　　(1) Advantages: Breast milk is the most ideal natural food for infants. Its advantages include: promoting the mother-child relationship; convenient, economical, hygienic, and safe; enhancing resistance; promoting brain development; developing intelligence; and benefiting the mother's postpartum recovery, etc.

　　(2) Dietary attention: Feed about 10 times a day, each for 15-20 minutes, and feeding frequency should not be controlled.

　　4. Artificial Feeding

　　Dietary attention: If there is no breast milk for the mother, it is only possible to feed the baby with milk products - mainly milk. However, it should be given in a quantitative, timed, and concentrated manner to the baby, with a concentration of 2:1 within 2 weeks; 3:1 within 3 weeks; 4:1 within 4 weeks. The concentration should be adjusted according to the baby's adaptation level, based on the stool, and attention should be paid not to overfeed. A small amount of sugar can be added, and if sweet milk powder is fed, sugar does not need to be added.

　　5. Mixed Feeding

　　Dietary attention: If breast milk is insufficient, artificial feeding should be provided to supplement the insufficient part. Add milk or milk powder appropriately every day according to the condition of breast milk.

　　Local treatment is the main approach, and generally, antibiotics are not needed.

　　1. Treatment during the acute stage: control infection and keep the local area dry

　　(1) Treatment of mild cases: Remove local scabs, use 3% hydrogen peroxide solution and 75% ethanol for cleaning at any time; adults can use hot salt water compresses; keep the umbilical area dry.

　　(2) Treatment of abscess: If the abscess has not localized, Jinyinhuang ointment can be applied externally around the umbilicus or physical therapy can be performed to localize the infection and promote the formation of abscesses and their rupture outward. After the abscess forms, incision and drainage should be performed.

　　(3) Treatment of systemic infection: Adequate broad-spectrum antibiotics such as penicillin should be administered if there is a large amount of pus or concurrent peritonitis and sepsis, and effective antibiotics should be selected according to the results of bacteriological examination.

　　(4) Supportive therapy: When systemic infection occurs, attention should be paid to fluid and electrolyte replenishment. Fresh whole blood, plasma, or albumin can be appropriately administered to enhance the body's immunity.

　　For small granulating wound in the chronic stage, 10% silver nitrate can be used for burning and then antibiotic ointment can be applied. For large granulating wounds, surgical excision or electrocoagulation to remove granulation tissue can be performed. Keeping the umbilical fossa clean and dry is sufficient for healing. Wounds with secretion are not suitable for talcum powder to avoid stimulating granulation tissue proliferation.